How to Identify Potential Complications Associated With Cheek-Teeth Extractions in the Horse

Oral surgeries involving the extraction of cheek teeth have a very high complication rate. Complications have been reported at 32% and as high as 70%. Recognition before occurrence helps the veterinarian to reduce the incidence and be prepared for a complication(s). Common indications for extraction include dental fracture, end-stage periodontal disease, severe decay/cavity, and periapical abscess. Typical complications include iatrogenic dental fracture (arising from ankylosis, resorptive lesions, decay, or incomplete/abnormally developed teeth), alveolar bone sequestration, paranasal sinus infection, alveolar plug failure, fistula (oroantral, oronasal, etc.), root-tip fracture, pathology extending to additional teeth, palatine artery laceration, and iatrogenic mandibular fracture. Oral and radiographic findings that would alert the clinician to complications associated with cheek-tooth extraction include: radiographic evidence of root-tip ankylosis, recognition of devitalized bone with oral and radiographic examination, identification of alveolar plug failure and gross contamination of the sinus with feed material, detection of an oroantral fistula with an intraoral mirror, evaluation of retained/fractured root tips for a periodontal ligament, radiographic evaluation of collateral pathology extending interproximal to neighboring teeth, detection of incomplete gingival reattachment and the formation of a small oral fistula, recognition of a palatal deviation of a cheek tooth that may predispose to an oronasal/oroantral fistula and/or a palatine artery laceration, and identification of immature and/or endodontically challenged teeth that may predispose to fracture during an extraction procedure. Author’s address: Laurel Highland Farm and Equine Service LLC, 2586 Northway Road Ext., Williamsport, Pennsylvania 17701, e-mail: [email protected]. © 2010 AAEP.